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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200481
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:51:35 PM

Document Has Been Signed on 10/11/2023 03:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:SVS OAKLAND ADULT DAY PROGRAMFACILITY NUMBER:
019200481
ADMINISTRATOR:RENE POCHEFACILITY TYPE:
775
ADDRESS:1830 EMBARCADERO SUITE 102TELEPHONE:
(510) 698-3990
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 60CENSUS: 43DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rene Poche, AdministratorTIME COMPLETED:
04:20 PM
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On 10/11/23 at 1:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator Rene Poche and explained the purpose of the visit. Day program operates from 8:00 a.m. to 3:00 p.m. Monday to Friday.

LPA toured facility including but not limited to: activity rooms, kitchen, bathrooms, office space, and the outside recreational area. Clients bring their own lunches and snacks are provided by the program. Cleaning supplies are locked and inaccessible to clients. Medications are not handled/dispensed by this program. There are no bodies of water or fire safety hazards observed. Restrooms are maintained in safe and in sanitary operating condition, and additional equipment for the physically handicapped was observed. Incontinent clients are kept clean and dry, and the facility is free of odors. The program has vans used for client outings and transportation. LPA reviewed 5 client and 5 staff files; all were complete. Emergency disaster drills are conducted monthly, the last one was on 9/22/23. Fire extinguishers throughout facility were last inspected 9/23/23. First aid kit was checked and observed to be complete.

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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